Department of Surgery, Division of General and Trauma Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina; Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Surgery, Division of General and Trauma Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina; Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Surg Res. 2021 Aug;264:454-461. doi: 10.1016/j.jss.2021.03.022. Epub 2021 Apr 10.
Blunt chest trauma is associated with significant morbidity, but the long-term functional status for these patients is less well-known. Return to work (RTW) is a benchmark for functional recovery in trauma patients, but minimal data exist regarding RTW following blunt chest trauma.
Patients ≥ 18 y old admitted to a Level 1 trauma center following blunt chest trauma with ≥ 3 rib fractures and length of stay (LOS) ≥ 3 d were included. An electronic survey assessing RTW was administered to patients after discharge. Patients were stratified as having delayed RTW (> 3 mo after discharge) or self-reported worse activities-of-daily-living (ADL) function after injury. Patient demographics, outcomes, and injury characteristics were compared between groups.
Median time to RTW was 3 mo (IQR 2,5). Patients with delayed RTW had higher odds of having more rib fractures than those with RTW ≤ 3 mo (median 10 versus 7; OR:1.24, 95%CI:1.04,1.48) as well as a longer LOS (median 13 versus 7 d; OR:1.15, 95% CI:1.04,1.30). Patients with stable ADL after trauma returned to work earlier than those reporting worse ADL (median 2 versus 3.5 mo, P < 0.01). 23.6% of respondents took longer than 5 mo to return to independent functioning, and 50% of respondents' report limitations in daily activities due to physical health after discharge.
The significant proportion of patients with poor physical health and functional status suggests ongoing burden of injury after discharge. Patients with longer LOS and greater number of rib fractures may be at highest risk for delayed RTW after injury.
钝性胸部创伤与显著的发病率相关，但这些患者的长期功能状态知之甚少。重返工作岗位（RTW）是创伤患者功能恢复的基准，但关于钝性胸部创伤后 RTW 的数据很少。
纳入年龄≥18 岁、因≥3 根肋骨骨折和住院时间（LOS）≥3 d 而入住 1 级创伤中心的钝性胸部创伤患者。在出院后，对患者进行了一项评估 RTW 的电子调查。将患者分为 RTW 延迟（出院后>3 个月）或自伤后日常生活活动（ADL）功能更差。比较两组患者的人口统计学、结局和损伤特征。
RTW 的中位时间为 3 个月（IQR 2,5）。与 RTW≤3 个月的患者相比，RTW 延迟的患者发生更多肋骨骨折的可能性更高（中位数 10 比 7；比值比：1.24，95%置信区间：1.04，1.48），且 LOS 更长（中位数 13 比 7 天；比值比：1.15，95%置信区间：1.04，1.30）。创伤后 ADL 稳定的患者比报告 ADL 更差的患者更早重返工作岗位（中位数 2 比 3.5 个月，P<0.01）。23.6%的受访者需要超过 5 个月才能恢复独立功能，50%的受访者因出院后的身体健康而在日常生活中受限。
大量患者存在身体健康和功能状态较差的情况，表明出院后仍存在持续的损伤负担。LOS 较长和肋骨骨折数量较多的患者在受伤后可能面临 RTW 延迟的最高风险。
